Prognostic value of N-terminal pro B-type natriuretic peptide and troponin Ⅰ in children with dengue shock syndrome

Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.

Predictors of hemorrhagic manifestations in dengue:A prospective observational study from the Hadoti region of Rajasthan

Objective:To study the laboratory and clinical predictors of hemorrhagic manifestations in dengue virus-infected patients.Methods:This was a single-center hospital-based prospective observational study.200 Dengue seropositive patients were included in the study.A detailed clinical examination was done and comprehensive laboratory investigations were done.These parameters were compared between patients with and without hemorrhagic manifestations.Results:Out of the 200 patients,47(23.5%)had bleeding.64.5%Patients were males and 76.0%were under the age of 40 years.The most common presenting symptoms were fever(100.0%)followed by myalgia(77.0%),nausea and vomiting(56.0%).Leukocytosis,neutrophilia,thrombocytopenia,hyperbilirubinemia,transaminitis,decreased serum albumins,and raised D-dimer can serve as hematological,biochemical,and coagulation predictors of hemorrhagic manifestations for dengue.Conclusions:Dengue is a tropical infection with various complications.Bleeding complications are one of them.Laboratory parameters like white blood cells,platelets,bilirubin level,liver enzymes,and D-dimer can help to identify patients at risk for bleeding.Early identification and appropriate management can save a lot of resources and lives.

Dengue fever leading to acute dengue hemorrhagic leukoencephalitis:A case report

Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.

Pituitary apoplexy secondary to dengue fever-induced-thrombocytopenia:A case report and review of literature

Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever,a sudden onset severe headache,and altered sensorium.Diagnosis:Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia.Interventions:Conservative management with fluids,mannitol,dexamethasone and symptomatic treatment.Outcomes:The patient responded well to the treatment and was discharged uneventfully.Lessons:Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy,it should be considered if a patient presents with headache and altered sensorium,and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.

Unilateral massive hemothorax in Dengue hemorrhagic fever:A unique presentation

Dengue hemorrhagic fever is a more serious form of disease characterised by plasma leakage syndrome,thrombocytopenia and disseminated intravascular coagulation.We present a 51 year old male who presented with fever,petechiae and acute onset of breathlessness.Emergency chest rhoentogram showed a massive riglit sided pleural effusion.On insertion of intercostal drain,there was a sudden gush of blood tinged fluid suggestive of hemothorax.There was no history of trauma or bleeding tendencies.Laboratory investigations revealed a raised hematocrit and severe thrombocytopenia.Dengue IgM was surprisingly positive.After aggressive supportive management the patient gradually improved and was discharged.While bilateral pleural effusion is a known occurrence in dengue hemorrhagic fever,massive hemothorax is unheard of.We report the first case in literature ol dengue hemorrhagic fever presenting as unilateral massive hemothorax.A suspicion of dengue must also be borne in mind in cases of non-traumatic hemothorax especially in endemic areas.

Femoral compressive neuropathy from iliopsoas haematoma complicating dengue hemorrhagic fever

Dengue fever is a debilitating mosquito-borne disease caused by dengue virus.We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever.Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis.Such manifestations are not well documented in the literature.The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed.

Dengue hemorrhagic fever and the liver

Dengue hemorrhagic fever(DHF)is one of the most rapidly emerging infections of tropical and subtropical regions worldwide.It affects more rural and urban areas due to many factors,including climate change.Although most people with dengue viral infection are asymptomatic,approximately 25%experience a selflimited febrile illness with mild to moderate biochemical abnormalities.Severe dengue diseases develop in a small proportion of these patients,and the common organ involvement is the liver.The hepatocellular injury was found in 60%-90%of DHF patients manifested as hepatomegaly,jaundice,elevated aminotransferase enzymes,and critical condition as an acute liver failure(ALF).Even the incidence of ALF in DHF is very low(0.31%-1.1%),but it is associated with a relatively high mortality rate(20%-68.3%).The pathophysiology of liver injury in DHF included the direct cytopathic effect of the DENV causing hepatocytes apoptosis,immunemediated hepatocyte injury induced hepatitis,and cytokine storm.Hepatic hypoperfusion is another contributing factor in dengue shock syndrome.The reduction of morbidity and mortality in DHF with liver involvement is dependent on the early detection of warning signs before the development of ALF.

Hematological indices as predictors of mortality in dengue shock syndrome: A retrospective study

Objective:To explore predictive hematological parameters on admission which are associated with mortality in NS1 positive dengue shock syndrome patients.Methods:Demographic characteristics,hematological parameters,and the outcome of NS1 positive dengue shock syndrome patients without any comorbidity and coexisting infections were collected from the Intensive Care Unit and the results were compared between the survivor and non-survivor groups.Results:The mean age was(30.77±11.48)years and 56(56.6%)patients were males.Out of the total 99 patients,72(72.27%)patients were successfully discharged and 27(27.27%)patients eventually succumbed to death.The most common hematological finding was thrombocytopenia(95.95%),followed by anemia(52.52%)and decreased mean platelet volume(37.37%).After controlling other variables,logistic regression analysis showed that absolute neutrophil count and mean platelet volume were associated with mortality.Conclusions:Total leucocyte count,absolute neutrophil count,and total platelet count are significantly higher,and mean platelet volume is significantly lower in the non-survivor group as compared to the survivor group.Absolute neutrophil count and mean platelet volume are predictors associated with mortality.

Dengue hemorrhagic fever and cardiac involvement

Dengue viral infection(DVI)is one of the world’s most significant viral infections spreading.Most of the patients have been asymptomatic,with relatively benign clinical manifestations and outcomes.However,a small number of patients have progressed to severe dengue diseases,including hemorrhage,multi-organ impairment,and increased vascular leakage causing hypovolemic shock,which can cause cardiovascular collapse and death.Numerous lines of evidence have demonstrated that DVI could also cause cardiac dysfunction,arrhythmias,and severe myocarditis.The treatment for dengue hemorrhagic fever(DHF)patients remains symptomatic and supportive,with close monitoring of hemodynamic status.The contributory role of cardiac dysfunction in DHF patients has potentially critical implications on the management.This review will address the current knowledge of cardiac involvement in DHF patients and the management strategy to reduce the fatality outcome.

Modeling and Forecasting Malaria and Dengue Hemorrhagic Fever Incidence and Prevalence in Northern Thailand

Malaria and dengue hemorrhagic fever （DHF） are infectious diseases prevalent in many tropical countries, including Thailand. Thailand is located geographically in a tropical zone and the transmission of malaria and DHF is common, particularly in the upper Northern region of the country. The objective of this study is to identify the patterns of hospital-diagnosed Malaria and DHF incidences by using the previous monthly or quarterly periods of incidences occurring in the upper Northern region of Thailand. The authors use additive plus multiplicative regression models to describe these patterns. The models can be used to forecast malaria and DHF incidences, thus predicting where epidemics are likely to occur. This information can be used to prevent disease outbreaks occurring. Graphical displays showing district and period effects are presented. The results of this study show that historical malaria and DHF incidence rates can be used to provide a useful model for forecasting future epidemics. The graphical display shows the improvement of risk prediction brought about by model. The model, even if based purely on statistical data analysis, can provide a useful basis for allocation of resources for disease prevention.

Diffuse alveolar hemorrhage complicating dengue haemorrhagic fever in a 15-year-old boy:A case report

Rationale:Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos.It can cause life threatening complications,including dengue haemorrhagic fever(DHF)and dengue shock syndrome.Patient concerns:A 15-year-old male presented with fever and petechiae and later developed hemoptysis.Diagnosis:Dengue fever with DHF with diffuse alveolar hemorrhage.Interventions:Invasive ventilation with high positive end expiratory pressure,multiple transfusions of packed red blood cells,fresh frozen plasma,single donor platelets and inotropic support Outcomes:The patient was stabilized and discharged on minimal supplemental oxygen.Lessons:Diffuse alveolar hemorrhage,although very rare,should be considered in a patient with dengue who presents with hemoptysis.The treatment is directed at providing respiratory and circulatory support,and preventing the progression of microcirculation damage.

Liver Damage during Dengue Fever in Ouagadougou

Dengue fever is widespread in all tropical and subtropical areas of the world and is the main public health problem posed by arboviroses. In Burkina Faso, an outbreak of dengue serotype “DENV-2”, which is responsible for severe forms of dengue, has been reported. In this study, we will discuss liver damage during this disease. The aim of this study was to describe the sociodemographic, diagnostic, therapeutic and evolutionary aspects of dengue patients with hepatic cytolysis. Patients and Methods: This was a prospective cross-sectional study of dengue disease in 2 facilities in the city of Ouagadougou. The study was spread over a period of 3 months from August to November 2019. The study population consisted of all patients hospitalised for dengue with a positive AgNS1 and/or IgM rapid diagnostic test (RDT) and presenting signs of liver damage. Results: During our study period we recruited 134 patients with dengue fever of which 93 or 69.4% had at least one elevated transaminase. The sex ratio was 1.90 and the average age was 35 years. Symptoms of liver damage were rare with right hypochondrial pain in 4.30% of cases and jaundice in 1.07% of cases. Dengue haemorrhagic fever was found in 5 patients. IgG was negative in 77.42%. The majority of patients (44% or 47.31%) had at least one transaminase value elevated to the upper limit of normal (ULN);and a minority, 14 patients or 15.06%, had transaminases above 10 ULN. A small proportion of patients had hepatocellular failure 26.92% with a lowered prothrombin level. Ninety-four per cent (94.62%) of the patients received analgesics. Level 1 analgesic (paracetamol) was the most widely administered, particularly in 76 patients (86.36%). More than half of the patients (57.14%) had a length of stay of less than or equal to 3 days and the outcome was favourable in 91.40%. Conclusion: Dengue virus causes alterations in the liver parenchyma. The degree of liver damage is variable. As clinical symptoms are almost non-existent, the measurement of transaminases remains important.

Significance of Serum Electrolyte Pattern in an Eastern Sudanese Dengue Fever Patients Population

Background: Dengue virus (DENV) infection is caused by an arboviral strain and is transmitted by the mosquito Aedes Egyties which is found in Sudan especially Red Sea and Kassala states in the east. In the year 2020 there was a significant outbreak in the both states. The disease is known to cause renal and electrolyte disturbances and a thorough understanding of that which will potentially help in the prediction, diagnosis and treatment of the disease. Methods: This study is a prospective observational cross sectional study conducted in the Eastern Sudan College of Medical Science and Technology and Port Sudan Teaching Hospital. 200 confirmed Dengue virus infection patients along with 200 healthy appearing adults (as a control) were enrolled for the study. Statistical analysis was carried out after the collection of patients’ demographic, clinical, and investigational data including electrolyte values. Results: The highest incidence of DENV infection was observed in individuals of the middle age group (29%). Although fallen within reference ranges found in the literature, mean serum electrolyte values differed significantly between patients and controls and between different categories of the disease. For our patients, hyponatraemia was seen in 43.5%, hypokalaemia in 37%, hypocalcaemia in 30%, hypophosphataemia in 12% and low magnesium concentrations in 13%. Mean serum sodium concentration differed in the control (138.2 mmol/l) from in the test (132.5 mmol/l) (P. value 0.02). Similarly, mean serum potassium in the control (3.97 mmol/l) differed significantly (P. value 0.01) from test (3.30 mmol/l). Mean calcium and phosphorus (8.80 and 3.50 mg/dl) in the control were also differed from test (8.51 and 3.30), (P. values 0.02 and 0.004, respectively). In contrast, serum magnesium (mg/dl) in the control group (1.96) showed no significant difference from that of test group (1.90) (P. value 0.08). The biochemical parameters studied were neither affected by age nor by gender of the patient group. Clinically, fever was present in 97.5% of patient, headache in 95.5%, joints pain in 71%, lethargy 67%, vomiting in 49%, skin rash in 40%, abdominal pain 24% and bleeding in 17.5%. Conclusion: We strongly conclude that electrolyte evaluation should be considered in the counseling of DENV infected patients. Patients need to be subjected to necessary laboratory investigations including serum electrolyte levels to decrease the rate of morbidity and mortality associated with the disease.

Prediction of Acute Renal Failure in Dengue Fever Patients

Background: Dengue virus (DENV) infection is caused by an arboviral strain and is transmitted by the mosquito Aedes aegypti which is found in Sudan especially Red Sea and Kassala states in the east. The disease is known to cause renal disturbances and a thorough understanding of that will potentially help in the prediction, diagnosis and treatment of the disease. Methods: This study is a prospective observational cross sectional study conducted in the Eastern Sudan College of Medical Science and Technology and Port Sudan Teaching Hospital. 200 confirmed Dengue virus infected patients along with 200 healthy appearing adults (control) were enrolled for the study. Statistical analysis was carried out after the collection of patients’ demographic, clinical, and investigational data including serum urea and creatinine values. Ethical approval was obtained from the ministry of health, Red Sea state and informed written consent was obtained from each participant. Results: The highest incidence of DENV infection was observed in individuals of the middle age group (29%). Elevated blood urea levels were detected in 10 (5%) patients while elevated creatinine levels were seen in 17 (8.5%) patients. Although fallen within reference ranges found in the literature, mean blood urea and creatinine values differed significantly between patients and controls and between different categories of the disease. Mean blood urea concentration showed a statistically significant difference between the control (22.3 mg/dl) and the test (28.4 mg/dl) (P value Conclusion: We strongly conclude that renal involvement is not uncommon in Dengue fever and that blood urea and creatinine evaluation should be considered in the counseling of DENV infection patients. Patients need to be subjected to necessary laboratory investigations associated with acute kidney injury to decrease the rate of morbidity and mortality associated with the disease.

Predictors of complicated dengue infections in endemic region of Pakistan

Objective:To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue.Methods:The study was conducted in a tertiary care hospitaldengue ward from September to November 2021 including confirmed dengue infected patients(positive NS1 antigen or antidengue-antibodies IgM).Secondary dengue infection was labelled by positive anti-dengue-antibodies IgG in active dengue infected patients.Detailed history,physical examination,laboratory and radiological parameters,hospital stay(days)and mortality percentages were noted.Patients were classified into three groups according to disease severity:dengue fever(DF),dengue hemorrhagic fever(DHF)and dengue shock syndrome(DSS).The predictors of complicated dengue infection were determined by regression analysis.Results:The most common symptom was fever(96.9%).Among 129 patients,62.8%had DF,31.0%had DHF and only 6.2%developed DSS.History of previous symptomatic dengue and positive anti-dengue-antibodies IgG were present in 100%DSS patients and nearly 75.0%DHF patients(P<0.05).The moratlity rate in patients with DSS,DHF and DF was 50.0%,2.5%and none respectively(P<0.05).Clinical parameters(body aches,bleeding,conjunctival hemorrhage,maculopapular rash,right hypochondrial tenderness,ascites,pleural effusion)and laboratory parameters(thrombocytopenia,raised alanine aminotransferase and secondary dengue infection)were determinants that complicate the dengue infection.Conclusions:Thrombocytopenia,raised alanine aminotransferase and secondary dengue infection are important laboratory parameters to complicate the disease process of dengue infection.

Trends of dengue infections in Malaysia,2000-2010

Objective:To analyze trends of dengue incidences and deaths in Malaysia from 2000 to 2010 as well as the predominant dengue virus serotypes during the last decade.Methods:We used the national data on annual reported cases,deaths,incidence rate,mortality rate,and case fatality rate of dengue fever(DF) and dengue hemorrhagic fever(DHF) as well as dengue virus serotypes prevalent in Malaysia during the last decade.Trend/ regression lines were fitted to investigate the trend of dengue incidences and deaths due to the disease for a 11-year period(2000-2010).For the distribution of national incidence rate,mortality rate,and case fatality rate of DF and DHF, descriptive statistics using mean and 95%confidence intervals(C/) for means,and range were applied.Results:The number of dengue cases and number of deaths have increased,on average, by 14%and 8%per year respectively.The average annual incidence rate of DF per 100 000 populations was higher as compared to that of DIIF.Conversely,the yearly mean mortality rate of DHF per 100 000 populations was greater than that of DF.The simultaneous circulation of all four dengue serotypes has been found in Malaysia.But a particular dengue virus serotype predominates for at least two years before it becomes replaced by another serotype.Conclusions: The dengue situation in Malaysia has worsened with an increasing number of reported oases and deaths during the last decade.The increasing trend of dengue highlights the need for a more systematic surveillance and reporting of the disease.

Critical analysis of the definition of severe dengue, based on the Ecuador outbreak in 2012

Of the 238 cases reported to the Ecuador Health Authorities in 2012 as severe dengue, only 53.3% met diagnostic criteria. The definition of severe dengue should be based on more precise criteria. Information about compliance with criteria should be fed back to local levels.

Molecular surveillance of dengue virus in Bahia State, Brazil

Dengue is an important emerging viruses, posing a threat to one-third of the global human population. In 2002, the introduction of DENV-3 in the state of Bahia produced massive epidemic (about 35,000 cases detected) and the first cases of dengue hemorrhagic fever. To understand the nature of the virus circulating at Bahia, E/NS1 sequence was determined for 31 DENV viruses isolated in Bahia during the 2006 and 2007 transmission season, from patients presenting with different degrees of severity. The carboxi-terminal region of the E gene (220 nt) of 31 viruses, isolated from dengue patients with clinical diagnosis of dengue infection were used to determine the genetic variability of dengue 2 (DENV-2) and dengue 3 (DENV-3). Sequence data were used in phylogenetic comparisons with global samples of DENV-2 and DENV-3. DENV-2 sample grouped in the South East Indian genotype, while DENV-3 samples were grouped within Indian genotype. This study is the first report on Bahia isolates during two transmission seasons. Our data confirms reports from other parts of Brazil and different countries showing the DENV-3 (geno-type III) strains circulating in the Americas are closely related, and cluster within the genotype that has been associated with DHF epidemics in different conti-nents.

Acute Hemorrhagic Fever: Clinical, Epidemiological and Laboratory Aspects in São Toméand Príncipe

Background: In the last 6 months, cases of acute hemorrhagic fever (AHF) have been recorded in Sao Tome and Principe (STP). Objective: To identify the clinical, epidemiological and laboratory parameters associated with AHF cases found in patients hospitalized in STP. Methods: Descriptive and quantitative analysis of AHF cases hospitalized in STP in the period December 2021 to May 19, 2022 through the variables: demographic data;clinical data;laboratory data and clinical outcome. Results: Analyzed 18 of 22 AHF cases, 50% of them male, mean age 33.7 years, 85.7% residing in the 2 largest districts of the country, 66.7% rural workers, administrative near maritime areas, sailors and domestics. 66.7% were healthy individuals. ≥50% had a fever, asthenia/weakness, myalgia, headache, lethargy, nausea, vomiting, and diarrhea. 22.2% to 33.3% had retro-orbital pain, abdominal pain, decreased consciousness, dyspnea/hypoxia, and cough. In a smaller register (5.6% - 11.1%), exanthema, convulsion, arthralgia, low back pain, chills, and chest pain. Bleeding from the digestive tract was found in 72.2%, followed by vaginal (33.3%), urethral (27.8%), nasal (22.2%), and oral (16.7%). 50% had laboratory confirmation for dengue, and another 50% with suspected clinical diagnosis without laboratory confirmation of the etiologic agent. Despite hemorrhage, 66.7% of confirmed cases were hemodynamically non-severe, and 88.9% of suspected cases were severe. Coinfection with malaria is evidenced in 11.1% of cases. 72.2% recovered and 27.8% died (deaths in 55.5% of suspected cases). Case deaths were male (100%), resident foreigners (40%), tool store employees, sailors and students, healthy (80%), and residing in the largest district in the country (60%). All deaths were hospitalized in serious condition, 80% were hospitalized for hemorrhage and shock, with bleeding arising between day 4 - 5 of illness in 60% and hospitalization on day 5 of illness. 60% died within ≤24 hours of hospitalization. 80% died from shock and multi-organ dysfunction and 20% from respiratory failure. Deaths had thrombocytopenia (100%), renal dysfunction (100%) and significantly increased transaminases (100%), anemia (75%) and leukocytosis (66.7%). 20% had a radiological change of pulmonary infiltrates. Conclusion: Our data reveal the complexity of the pathogens causing AHF and suggest the possible presence of other human pathogens usually unknown in the Santomean geographical territory.

Progress towards understanding the pathogenesis of dengue hemorrhagic fever

Dengue virus(DENV) is a mosquito-borne virus belonging to the Flaviviridae family. There are 4 serotypes of DENV that cause human disease through transmission by mosquito vectors. DENV infection results in a broad spectrum of clinical symptoms, ranging from mild fever to dengue hemorrhagic fever(DHF), the latter of which can progress to dengue shock syndrome(DSS) and death. Researchers have made unremitting efforts over the last half-century to understand DHF pathogenesis. DHF is probably caused by multiple factors, such as virus-specific antibodies, viral antigens and host immune responses. This review summarizes the current progress of studies on DHF pathogenesis, which may provide important information for achieving effective control of dengue in the future.